Thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma with clinically significant portal hypertension: propensity score matching study

Yinglin Long; Zhou Yang; Qingjing Zeng; Zhongqi Liu; Erjiao Xu; Xuqi He; Lianxiong Yuan; Binsheng Fu; Kai Li

doi:10.3389/fonc.2023.1103347

Thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma with clinically significant portal hypertension: propensity score matching study

Front Oncol. 2023 Jun 26:13:1103347. doi: 10.3389/fonc.2023.1103347. eCollection 2023.

Authors

Yinglin Long¹, Zhou Yang², Qingjing Zeng¹, Zhongqi Liu³, Erjiao Xu¹, Xuqi He¹, Lianxiong Yuan⁴, Binsheng Fu², Kai Li¹

Affiliations

¹ Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation, Research Center of Guangdong Province, Guangzhou, China.
³ Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
⁴ Department of Science and Research, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

Purpose: The objectives were to investigate the safety and efficacy of thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma patients with clinically significant portal hypertension (CSPH).

Materials and methods: From July 2016 to September 2019, hepatocellular carcinoma patients with CSPH treated by liver transplantation (N=37) or thermal ablation (N=114) were enrolled. Cumulative intrahepatic recurrence, overall survival and major complications were compared by propensity score matching.

Results: In the two matched groups, the 1-, 2-, and 3-year intrahepatic recurrence rates for the ablation group (22.3%, 50.0%, and 50.0%, respectively) were significantly higher than those for the transplantation group (4.5%, 4.5%, and 4.5%, respectively) (P=0.016). The 1-, 2-, and 3-year overall survival rates were comparable between the two groups [96.1%, 88.7%, and 88.7%, respectively (ablation group) vs. 84.6%, 76.2%, and 76.2%, respectively (transplantation group)] (P=0.07). The major complication rate for the ablation group [4.8% (3/62)] was significantly lower than that for the transplantation group [36.0% (9/25)] (P<0.001).

Conclusions: Thermal ablation is a safe and effective alternative for hepatocellular carcinoma patients with CSPH.

Keywords: hepatocellular carcinoma; liver transplantation; portal hypertension; propensity score matching; thermal ablation.

Grants and funding

This work was supported by the National Key Research and Development Program of China under Grant No. 2017YFC0112000; the National Natural Science Foundation of China under Grant No. 81430038; the China Primary Health Care Foundation under Grand No. 2022-003; the Science and Technology Planning Project of Guangzhou, China under Grant No. 201704020164; and the Research Fund for Young Teacher Training Project of Sun Yat-sen University under Grant No. 18ykpy05.